S.Olatunbosun BANJOKO, Mynepalli K.C. SRİDHAR

Mikobakteriyum Tüberkülozis Tanısında Hızlı İmmünokromatografik Serolojik Yöntemin Klinik Değerlendirmesi

AMAÇ: Tüm tüberküloz vakalarını tarıyacak tek bir tanı yöntemi yoktur. Bu nedenle tanı birkaç gün veya hafta sürebilir, pahalı, invazif ve karmaşıktır. YÖNTEM: Ibadan, Nijerya'da Jericho Göğüs kliniği'nde takip edilen 100 klinik tanılı almış tüberküloz hastası (Deney grubu) ve tüberkülozu olmayan 100 sağlıklı kişi (Kontrol grubu) çalışmaya alındı. İmmün kromatografik stripler üzerinde hareketsizleştirilmiş antijenlere dayanan hızlı serolojik test kontrol ve deney grubundaki tüm deneklere uygulandı. Kontroller klinik muayene ve rie grafi, mikroskopi ve bakteri kültürü yapılarak seçildi. Tüberküloz hastalarının da pozitifliği aynı şekilde doğrulandı. BULGULAR: Gerçek pozitif sayısı 78 (%78) ve yanlış positif sayısı 8 (%8) iken gerçek negatifler 92 (%92) ve yanlış negatifler 22 (%22) idi. Serolojik yöntemin sensitivite, spesifite, negatif prediktif değer ve positif prediktif değerleri sırasıylaşöyleydi: %78,0, %92,0, %80,7 ve %90,7. SONUÇ: Bu sonuçlar serolojik yöntemi tanı ve özellikle fakir ve gelişmekte olan ülkelerde tüberkülozun idaresi noktasında rutin uygulamaya sokmak için düşüktür. Ayrıca, hızlı serolojik tanı için çoklu antijene dayalı immünkromatografik kitlerin daha fazla umut verici olduğu söylenebilir.

[Clinical Evaluation of a Rapid Immunochromatographic Serological Method in the Diagnosis of Mycobacterium Tuberculosis]

AIM: There is currently no single diagnostic method which can detect all tuberculosis (TB) cases. Therefore diagnosis can take several days and weeks and involve expensive, invasive and complex procedures. METHODS: 100 clinically diagnosed tuberculosis patients attending Jericho Chest Clinic, Ibadan, Nigeria (Test) and 100 tuberculosis free healthy individuals (Control) were recruited for the study after ethical clearance and patients' consent were obtained. Rapid serological test based on immobilized antigens on immune-chromatographic strips obtainable from (AMRAD, Australia) were performed using serum samples of clotted blood obtained from test and controlled subjects. Controls were selected using results of clinical examination and chest X ray while the tuberculosis patients were confirmed positive using clinical examination, chest X-ray, smear microscopy and microbial culture. RESULTS: The number of true positives were 78 (78.0%) and false positives were 8 (8.0%) while the number of true negatives were 92 (92.0%) and false negatives were 22 (22.0%). Sensitivity, specificity, negative predictive and positive predictive values of this serological method were 78.0%, 92.0%, 80.7% and 90.7% respectively. CONCLUSION: These results underscore the need to include serological method as a routine in the diagnosis and management of tuberculosis at the point of care particularly in poor resource settings and developing economies. Furthermore it is plausible to suggest that multiple antigen based immunechromatographic kits showed better promise for rapid serological diagnosis.

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